Provider Demographics
NPI:1700845344
Name:BERESH, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BERESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 NW WASHINGTON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-6384
Mailing Address - Country:US
Mailing Address - Phone:513-869-7399
Mailing Address - Fax:
Practice Address - Street 1:840 NW WASHINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6384
Practice Address - Country:US
Practice Address - Phone:513-869-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086579207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614602Medicaid
OH2614602Medicaid